Divided Total Thyroidectomy with Medial to Lateral Dissection

Ahmed E Lasheen*, Ahmed Farag, Tamar Wasefy, Alaaelden Ramadan, Amr Foad, Said Nagm and Omar A Lasheen

Background: Traditional total thyroidectomy is still associated with serious complications, especially when abnormal recurrent nerve anatomy is present. In divided thyroidectomy, dissection is started from medial to lateral, saving every structure passing through the thyroid gland or from it. 

Methods: Our study included 20 patients suffering from multinodular goiter (15 females and 5 males). Under general anesthesia with an endotracheal tube. The thyroid gland is divided in medline infrant of trachea, and dissection starts from medial to lateral using bipolar diathermy, until freeing the gland from all blood supply and adhesion directly on the thyroid capsule. The wound is closed in layers with a drain.

Results: The mean patient age is 42.7 years (ranging from 25 to 52 years). The mean operative time was 45 minutes. The skin incision lies at the lower neck crease and extends from the medial border of one sternomastoid muscle to the other. No complications were observed intra-operatively or postoperatively, which extended to 4 months. 

Conclusion: Our technique is minimally invasive, easy to learn, and safe even with the presence of abnormal anatomy in or around the thyroid gland. 

*Traditional total thyroidectomy starts dissection from the lateral side, facing the medial thyroid veins, which are ligated, making the gland more congested, the field bloody, the procedure more difficult, and liable to injuries to important structures.

*Our technique starts dissection from medial to lateral, facing arteries first and distal parathyroid glands, avoiding injuries to important structures near or inside the thyroid parenchyma. 

Keywords:

Published on: Jun 6, 2026 Pages: 5-7

Full Text PDF Full Text HTML DOI: 10.17352/2455-2968.000170
CrossMark Publons Harvard Library HOLLIS Search IT Semantic Scholar Get Citation Base Search Scilit OAI-PMH ResearchGate Academic Microsoft GrowKudos Universite de Paris UW Libraries SJSU King Library SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat VU on WorldCat